SPNS IHIP Oral Health Webinar Series: Dental Case Management.Presented by Dr. Howell Strauss and Nelson Diaz of AIDS Care Groupand Dr. Carolyn Brown and Lucy Wright of the Native American Health Center January 9, 2014

AgendaIntroduction to SPNS Integrating HIV Innovative Practices (IHIP) projectSarah Cook-Raymond, Managing Director of Impact Marketing + Communications

Presentations AIDS Care Group of Chester, PADr. Howell Strauss, Executive Director & DentistNelson Orlando Diaz, Dental Case Manager & Community Health WorkerNative American Health Center of San Francisco, CADr. Carolyn Brown, Dental Director, Programs & DevelopmentLucy Wright, RDA, Dental Program Coordinator & Former Patient Navigator

Q & A

IHIP Resources onTARGET Center Website www.careacttarget.org/ihip

IHIP Oral Health ResourcesTraining Manual

Curriculum

Pocket Guide

Webinar SeriesHealthy Mouth, Healthy Body (Held Dec. 13)Dental Case ManagementClinical Aspects of Oral Health Care for PLWHA

Recording and slides for all Webinars will be uploaded to TARGET Center Web site following the live event: www.careacttarget.org/ihip

Other IHIP ResourcesBuprenorphine TherapyTraining Manual, Curriculum, Monograph, and Webinars on implementing buprenorphine in primary care settingsEngaging Hard-to-Reach PopulationsTraining Manual, Curriculum, and Webinars on engaging hard-to-reach populationsJail LinkagesTraining Manual, Curriculum, Pocket Guide, and Webinars on enhancing linkages to HIV care in jails settings

UPCOMING: Hepatitis C Treatment ExpansionIn Spring/Summer 2014, look for training materials on increasing access to and completion of Hepatitis C treatment for PLWHA on the TARGET Center Web site.

AIDS Care GroupOutreach and Dental Case Management

Clinical servicesMedicineDentistryMedical case managementNutritionPsychiatryPsychosocial services

Social and Medical Factors Affect Individual and Community HealthThere is poverty, joblessness, homelessness, and despair.Crime, substance abuse behaviors, and/or mental health conditions affect access to and retention in care.Dental care historically lacking in this targeted population.

Historical Review of Access to Dental Care1980s: Regardless of ability to pay, dental care was inaccessible.Early 1990s: One of two dental schools in Philadelphia accepted HIV positive patients.Middle 1990s: Americans with Disabilities Act: All dental practices are offices of public accommodation.

History continuesNew ways devised to deny dental care: This office does not accept Medicaid dental insurance.

Barriers to CareFear of the dentistInability to payNeed to be asleepNo way to get thereOther family and health issues

Newly Constructed BarriersTo get care in the Ryan White setting, you must present your papers.Papers, please.

Special ProjectsThe AIDS Care Group was awarded a Special Projects of National Significance grant for Oral Health Care Outreach ProjectA new clinic was established in Coatesville in October, 2006

Dental Case Management

Outreach stresses the need to go where people are receiving the most basic of their needs.It can mean meeting people in hospitals, food distribution centers, religious meeting places, or social service agencies. It can also mean meeting people in prisons and jails, drug and alcohol treatment centers, or crack-houses.The dental case manager is the glue that keeps the program together.

Linked patients, papers, and providers.Liaison between medical and social services providers, family members, and dental staff.Transportation: New van logged 35,000 miles in first year of operation; exclusively for the dental outreach program.Other enhancements: food, clothing, gas cards, chief kibbitzer.

New dental clinic established.New dentist hired.Staff added from the community.Outreach provided to multiple communities.Start-up time: 4 months.Full patient schedule within 6 months.Over 600 patients treated.

Program sustained to this day, using the same model of outreach and removing barriers to care.

2014 HRSA/SPNS IHIP Dental Case Management WebinarNative American Health Center

Carolyn Brown, DDSLucy Wright,RDADental Director Dental Program CoordinatorFormer Patient NavigatorCarolynb@nativehealth.orgLucyw@nativehealth.org

Building the Case for NAHCs Patient Navigator (Pre-2006)Wide range of dental services offered at NAHCCompact dental team focusing on clinical servicesReferrals for HIV+ persons from 14+ agencies to NAHC dentalSporadic success in managing dental treatment Sometimes resulted in incomplete appointments, missed appointmentsConfusion on the part of the patient, NAHC and referring agencyDentist or over burdened receptionist often requesting + med infoMost treatment plan completions for patients with the least amount of access issues35% no-show rate for dental appointments from HIV+ patients referred from partner agencies1

1- Goddard G, Brown C, and Ahmad S: Oral Disease Prevalence among HIV-Positive Native American Indians in an Urban Clinic, Journal of Psychoactive Drugs, Vol 37 (3), Sept 2005. PMID: 16295015

Creating Dental Case ManagementThe chicken or the egg?

Option 1:Dental staff and train for case management

Option 2:Case manager and upgrade dental i.q.

Patient Navigator-GOALSIncrease AccessIdentify barriers to care during interviews, and treatment; customize support or ancillary servicesIntro the idea of a dental homePatient will identify with NAHC, their dentist, and dental case manager as THEIR provider, fostering understanding and motivation towards treatment plan completionBuild Team MentalityBuild cohesiveness of the dental teamBridge resources with medical case managersBridge resources for referralsPartner w. the patient, and care givers to meet their needs and accomplish their dental goalsIdentify other medical or community resources for the patient

Patient Navigator- A Day in the Life of9a -HIVQUAL audit prep930a- Pick up food from Food Bank10a- Accompany patient to the oral surgeon 11a- Call 10 patients for appt reminder; Remind 1 patient to bring lab work1130a-Coordinate with oral sxs office on patients f/u instructions12p- Answer patients email who is confused about appt time; review incoming faxes and lab work2p- Intake 2 new patients; f/up with 1+3p- Meet with DDS to review tx plan progress4p- Review treatment plans with DDS430a- Call patient from oral surgery appt; follow-up5p- Meet with 1 patient after dental appointment

Findings from the SPNS projectsClinical:Improvement in overall health statusMore likely to complete Phase 1 treatment plansMore likely to be retained in dental care

Patients:Availability of DCMIncrease accessKnowledgeEmpathy and offer comfortPatients credited overall health improvement to DCMLeMay, Tobias, Umez-Eronini, Brown,McCluskey, Fox, Bednarsh and Cabral.Dental case manager encounters: the association with retention in dental care and treatment plan completion. Spec Care Dentist. 2013 Mar-Apr;33(2):70-7. LeMay, Cashman, McDonald, Graves. A new approach to ensuring oral health care for people living with HIV/AIDS: the dental case manager. Prev Chronic Dis.2012;9:E158.

NAHC HOPE/SPNS Study 2007- 2010 ResultsDCM (n= 85) and non-DCM patients (n=205) very similar populationsDCM patients had significantly higher:Phase 1 treatment plan completionLow intensity preventative treatmentsHigher number of dental appointments/yrHigher likelihood of keeping appt.Higher reported oral health quality of lifeBrown C, Ponnala S, Kim J. Oral Presentation: Maximizing Clinical and Health Outcomes: HIV+ Dental Case Management. International Association for Dental Research, Miami, FL. April 1-4, 2009.

NAHCs Patient Navigator SuccessNo show rate for HIV+ dental patients at 5% from 35% over 4 years118 patients who have been out of care recruited and retained88+ specialty referral appointments kept and treatment receivedClose partnership with 10 medical clinics specializing in HIV+ careAdded 2nd Dental Case Manager; Ratio was 40-50 patients : 1 DCM

The State and Future of HIV Research Goal #3: Optimizing treatment and care of the HIV-infected individualI never really had good teeth, but my T cells have actually gone up to 600 since Ive been here getting my teeth fixed. My health improved so much; Im so grateful! I never realized that I needed help in getting here. I love Lucy, my DCM. Mike M.

Strategies for Success

NAHC SPNS TeamSridevi Ponnala, DDS, Clinical Director Carolyn Brown, DDS, Dental Director Eulalia Valerio, Director, Projects & Evaluation Lucy Wright, RDA, Dental Patient Navigator Gloryanna Valerio-Leonce, Data & Intake Manager

Next Oral Health Webinar

Clinical Aspects of Oral Health Care for PLWHAJanuary 22, 2014 at 3 PM ESTMore information available at: https://careacttarget.org/library/clinical-aspects-oral-health-care-plwha

Presenters:Dr. David Reznik, HIVDent and Grady Health System of Atlanta, GAMs. Helene Bednarsh, RDH, MPH, HIVDent and Boston Public Health Commission of Boston, MA

Q & A

Twitter: @impactmc1| Facebook: ImpactMarCom |www.impactmc.net | 202-588-0300

Connect with UsSarah Cook-Raymond, Managing Director |Impact Marketing + Communications

. *********************Good morning. This is Dr. Carolyn Brown and Lucy Wright, RDA from the Native American Health Center in San Francisco. Our agency is a community health center located in the citys Mission District. We have been providers of excellent dental care for Persons Living with HIV/AIDS since the 1980s.*NAHC receives referrals from many, many agencies. We receive funding for only 75 unique dental patients per year, which is about 5 times less than the number of active dental patients with HIV/AIDS on record here.******Thank you for your time-My contact information and the Impact Marketing + Communications Website are at the bottom, so please feel free to reach out any time if you have questions about our firm, the IHIP work or any other HRSA deliverables weve created, or if there are any marketing or communications projects we can help you with.- At this time, Id be happy to take any questions you have about the IHIP project. We will also turn to Q&A with the other presenters.*